Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial.
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Fernández Jorge, Francisco Cristina, Seoane-Pillado Teresa, Estany-Gestal Ana, Vázquez Olalla, Aguirre Pilar, López Rosa María, Lluch Aitana, Repáraz José Ramón, Vilar Anxo, Arana Valentín, Ceresuela Reyes, Mirón Paula, González Almudena, Romero Jose Daniel, Otero María Teresa, González Mariana, Carballo Jesús, Mínguez Laura, Blanco María Luisa, Peiteado Marcos, Casas Pablo, Fernández Jonatan, Martínez-Ragües Gema, Rodríguez Alfonso, López David, Vargas Miguel José, Pereira Denis, Cortiñas Julio, García Adrián, Blanco María, Sandoval María, Bolón Alberto, Suárez Patricia, Argente Pilar, Lamas Aurora, Ferreiroa Esteban, Vilela María, Taboada Manuel
Аннотация
METHODS: In this multicentre, randomised trial conducted in four Spanish hospitals, we assigned adults undergoing surgery requiring lung isolation to receive double-lumen tube intubation with either videolaryngoscopy or direct laryngoscopy. The primary outcome was successful intubation on the first attempt. Secondary outcomes included glottic visualisation, ease of intubation, external airway manipulation, oesophageal intubation, double-lumen tube malposition, and other peri-intubation complications.
RESULTS: Among the 916 patients enrolled, successful first-attempt intubation occurred in 388 of 458 (84.7%) participants in the videolaryngoscopy group and 352 of 458 (76.9%) in the direct laryngoscopy group (absolute risk difference 7.9 percentage points; 95% confidence interval [CI] 2.8-12.8; P=0.003). A total of 429 participants (93.7%) in the videolaryngoscopy group and 370 (80.8%) in the direct laryngoscopy group had good glottic visualisation (absolute risk difference 12.9%; 95% CI 8.6%-17.1%; P<0.001). Videolaryngoscopy was associated with a higher rate of easy intubation (81.9% vs 68.6%; absolute risk difference, 13.3%; 95% CI 7.8%-18.8%; P<0.001) and reduced external airway manipulation (28.6% vs 40.6%; P<0.001), loss of glottic view (4.4% vs 21.8%; P<0.001), oesophageal intubation (1.7% vs 4.6%; P=0.014), and double-lumen tube malposition (7.6% vs 12.4%; P=0.016). Intubation time and other complications were similar between groups.
CONCLUSIONS: Among patients undergoing surgery requiring lung isolation, videolaryngoscopy increased first-attempt success and improved glottic visualisation while reducing procedural difficulty in double-lumen tube placement compared with direct laryngoscopy.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT06401486.